| NPI | 1609396001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: NC 14438) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OH SP12507) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-02-13 |